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ADVERSE REACTIONS
The Food and Drug Administration encourages all health care providers to report serious, adverse reactions and product defects associated with medications, devices and nutritional products to their department through their MEDWATCH reporting system. Submit a voluntary report on Form #3500, or report by phone, fax or Internet via the numbers and web address below. The FDA also publishes a guide for health care providers, The FDA Desk Guide for Adverse Events and Product Problems. For more information, contact the FDA at: 800-FDA-1088, 800-FDA-0178 (FAX) or www.fda.gov/medwatch 

ADVERTISING
Laws regulating advertising are a part of the Louisiana State Dental Practice Act. Refer to Louisiana Revised Statutes 37:774–776 and Rule 301 of the Rules and Regulations of the Louisiana State Board of Dentistry (LSBD). All the rules and regulations as well as the Laws of the State of Louisiana Governing the Practice of Dentistry—commonly known as the Dental Practice Act—are included in a booklet published by the LSBD. Dental licensees receive the booklet along with their license renewal. For additional copies, contact:

Louisiana State Board of Dentistry, One Canal Place, Suite 2680, 365 Canal Street, New Orleans, LA 70130, 504-568-8574, www.lsbd.org

AMERICANS WITH DISABILITIES ACT
This federal law protects disabled persons from discrimination in employment, hiring, transportation, access to public facilities and services and telecommunications. Title III of the ADA prohibits discrimination against hearing-impaired individuals in public places, including dental offices. Health care providers can be required to furnish interpreters for hearing impaired patients at no cost to them, if doing so is necessary to achieve equal and effective communication.

The law also prohibits discrimination in services, including dental care, to persons with physical or mental disabilities, which many courts have held to include HIV infection. Under the ADA, a person with a physical or mental impairment that substantially limits a major life activity is considered disabled, as well as a person wit a record of having such impairment and a person who is regarded as having such impairment.

For more information on dentists’ obligations under the Act, call: U.S. Justice Department Information Line, 800-514-0301, ADA Technical Assistance, 800-949-4ADA, www.adata.org

ANTIBIOTIC PROPHYLAXIS
In 1997, the American Heart Association issued new guidelines for dentists and physicians treating patients at risk for bacterial endocartitis. The key points include:
•  In most cases, endocartitis is not attributable to invasive procedures.
•  Cardiac conditions are stratified into risk categories based on potential outcome if endocartitis develops.
•  Procedures that cause bacteremia and for which prophylaxis is recommended are more clearly specified.
•  An algorithm was developed to more clearly define when prophylaxis is recommended for patients with mitral valve prolapse.
•  For oral/dental procedures, the initial amoxicillin dose is reduced to 2g, a follow-up antibiotic dose is no longer recommended, erythromycin is no longer recommended for penicillin-allergic individuals, but clindamycin and other alternatives are offered.

A complete summary of the guidelines is available in the August 1997 issue of JAMA. A copy of the American Heart Association’s complete recommendations is available by phone or online at: 800-242-8721 or www.americanheart.org/presenter.jhtml?identifier=1729

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ANTIBIOTICS, EFFECT ON ORAL CONTRACEPTIVES
Women of childbearing age should be aware of possible reduced efficiency of oral contraceptives during antibiotic therapy. They should be advised to use additional contraceptives during the antibiotic usage and to consult their physicians about the possibility of higher doses of oral contraceptives. The patient should sign a form attesting to her knowledge of this situation, and the form should be kept in the patient’s treatment record.

ANTITRUST
Dentists should be aware of the civil and criminal implications of collective negotiation and other group activity, particularly in the context of dealing with managed care plans. For general information or assistance with specific issues related to antitrust laws, contact the ADA Department of Legal Affairs at 800-621-8099. Or, you can check ADA Online for antitrust information related to managed care at: http://www.ada.org/members/advocacy/issues/antitrust.asp

CHEMICAL DEPENDENCY
According to the American Dental Association’s Principles of Ethics and Code of Professional Conduct, it is unethical for dentists to practice while abusing controlled substances, alcohol or other chemical agents which impair their ability to practice dentistry. Additionally, if a dentist has firsthand knowledge that a colleague is practicing dentistry while so impaired, he/she has an ethical responsibility to report evidence to the dental association’s professional assistance committee. The LDA has established the Dentists’ Well-Being Advisory Committee to help the dentist, his/her family or other concerned parties into treatment for chemical dependency. This committee is bound to handle all inquiries in strict confidence.  Contact the LDA at 800-388-6642 or 225-926-1986 or e-mail: info@ladental.org

CHILD ABUSE
According to Louisiana Revised Statute 14:402-403.4, a “mandatory reporter” of child abuse includes any individual who provides health care service. This includes dentists and their staffs. Any “mandatory reporter” who has cause to believe that a child’s physical or mental health is endangered due to abuse or neglect shall report to either the local child protection unit or to the local or state law enforcement agency. Any person who makes a report in good faith and cooperates in any investigation is immune from civil or criminal liability, except when the reporter is an alleged principal, conspirator or accessory to any abuse, or the report is knowingly false or submitted with reckless disregard for the truth. The Louisiana Children's Code, Article 609, A.(2) states the following: "Violation of the duties imposed upon a mandatory reporter subjects the offender to criminal prosecution authorized by R.S. 14:403(A)(1)."

For more information, contact: Prevent Child Abuse Louisiana, 733 East Airport Avenue, Suite 101, Baton Rouge, LA 70806, 800-348-KIDS, 225-925-9520, www.pcal.org or e-mail: info@pcal.org

CLEFT LIP / CLEFT PALATE INSURANCE COVERAGE
Louisiana law requires certain insurance policies to provide coverage and certain benefits for the medical condition of cleft lip and cleft palate. Title 22 of the Louisiana Revised Statues, §215.8 requires any hospital, health, or medical expense insurance policy, hospital or medical service contract, employee welfare benefit plan, health and accident insurance policy, or any other insurance contract of this type, including a group insurance plan, and a self-insurance plan that provides medical and surgical benefits which is delivered, issued for delivery or renewed in this state on or after January 1, 1998, shall include coverage for the treatment and correction of cleft lip and cleft palate.  Such coverage shall also include benefits for secondary conditions and treatment attributable to that primary medical condition.  

For more information on the benefits included with cleft lip or cleft palate insurance coverage, contact the LDA at 800-388-6642, 225-926-1986 or e-mail: info@ladental.org

CLOSING A DENTAL PRACTICE
The ADA developed a brochure titled "Closing A Dental Practice: A Guide for the Retiring Dentist or Surviving Spouse." Download this brochure for information on managing patient records, dismissing staff, disposing of equipment and supplies and necessary notifications. The information also contains sample letters and tips on ways to close a dental practice at retirement or in the event of a dentist's long-term illness or death.

CONSUMER CREDIT
According to Louisiana Revised Statutes 9:3563-3567, any person engaged in consumer credit sales or consumer loans or person who takes assignments of and undertakes direct collection of payments from or enforcement of rights against debtors arising from these sales or loans shall file notification with the Commissioner of Financial Institutions within 30 days after commencing business within the state, and no later than April 1 of each calendar year thereafter. An entity with consumer credit sales of $500,000 or less in the preceding year must remit a $75 fee with the notification. If the notification and fee have not been received by April 15, the entity is subject to a $50 late fee; thereafter, an entity is subject to forfeiture of credit privileges if the notification, fee, and late fee are not received by May 30. Notification and fee filing are not required by Louisiana licensed lenders or by any person whose only act of extending credit is the making of a sale to a consumer by honoring a credit card issued by a supervised financial organization, where such seller receives payment for the sale from the credit card issuer and retains neither interest in the extension of credit, nor a right of recourse against the buyer in the event of non-payment of the account. For more information, call: Office of Financial Institutions, Consumer Credit Division, P.O. Box 94095, Baton Rouge, LA 70804-9095 or 225-925-4660.

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DENTAL FAIRNESS ACT
Louisiana law prohibits discrimination against dental care services under specific circumstances. Louisiana Revised Statute 22:213.1 provides that payment for health care services shall not be denied under a policy, contract or other document providing for the payment of health care treatment procedures if the services are rendered by a licensed dentist if the following two conditions are met:
1.   The health care services would be covered if provided by a person licensed to engage in the practice of medicine and surgery, and
2.   The health care services can be lawfully performed within the scope of practice of a licensed dentist.

For more information on the Dental Fairness Act, contact the LDA at 800-388-6642, 225-926-1986 or e-mail: info@ladental.org

DENTAL HANDPIECE STERILIZATION & DISINFECTION
The Centers for Disease Control recommends that dental instruments that can withstand high temperatures should be sterilized: (1) in a steam autoclave, (2) with dry heat in an oven-like environment, or (3) using chemical vapor. All others should be scrubbed clean and sterilized/disinfected in chemical solutions. Use disinfection procedures on surfaces and equipment that cannot be removed for sterilization. They include counter tops, drawer handles, x-ray unit heads and light handles. The CDC publication Recommended Infection-Control Practices for Dentistry is included in the booklet published by the Louisiana State Board of Dentistry and may be downloaded via: Division of Oral Health, Centers for Disease Control, 770-488-6055 or http://www.cdc.gov/

DENTAL SERVICE CONTRACTORS LAW
Louisiana Revised Statutes 22:1511 states that “No person shall act as or hold himself out to be a dental service contractor in this state, unless that person has qualified and has been issued a certificate of authority as a domestic insurer or has been admitted to transact business in this state and issued a certificate of insurance as a foreign or alien insurer under this Title... Every dental service contractor operating in this state shall be regulated by the commissioner as a domestic or foreign health and accident insurer and shall meet all of the requirements established by this Title applicable to health and accident insurers, including all capital, surplus and deposit requirements. For purposes of regulation, a contract between a dental service contractor and a subscriber shall be considered a health and accident insurance policy, and the subscriber shall be considered a policyholder...”

DENTIST-PATIENT RELATIONSHIPS (TERMINATION)
These basic guidelines should be considered when terminating dentist-patient relationships:
1.   Dental treatment in progress must either be completed so the patient’s health will not be jeopardized or the patient should be referred to another qualified dentist or specialist;
2.   Before terminating a dentist-patient relationship, a dentist should seek advice from an attorney and/or malpractice insurance carrier;
3.   To end this relationship, the dentist should send the patient a written notification via certified mail, return receipt requested. The notice to the patient should include the date the relationship will end (allowing reasonable notice), suggestions on how to find another dentist, an offer to forward the patient’s records to a new dentist, an offer to provide emergency care for a reasonable period of time, and a statement of the current status of care and future need for treatment; and
4.   AIDS or HIV positive diagnoses are typically not valid reasons for termination.

For more information, visit www.ada.org  for more information on business and practice management employment issues.

DRUG LICENSE REGISTRATION
For a license to write prescriptions in Louisiana, contact the LA Department of Health and Hospitals, Controlled Dangerous Substances Section, P.O. Box 3767, Baton Rouge, LA 70802 or 225-342-9404.

After completing your application, return it along with a $20 check to the above address. You should also include a copy of your dental license which shows the date of expiration. You will then be assigned a Controlled Dangerous Substances (CDS) number. You should then request a copy of Form 224 (Form 224a for renewals) from the Federal Drug Enforcement Administration. Forms are available online at www.deadiversion.usdoj.gov/drugreg/reg_apps/index.html.

Return the form to the DEA with the $390 registration fee. For more registration information, contact the DEA field office:
Registration Unit of the U. S. Department of Justice
Federal Drug Enforcement Administration
3838 North Causeway Blvd., Suite 1800
Three Lakeway Center
Metairie, LA 70002
504-840-1063 or 888-514-7302
For general information, call the DEA at 800-882-9539.

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EMERGENCY CARE: THE GOOD SAMARITAN ACT
Louisiana Revised Statutes 37:1731 (D) provides that “No dentist licensed under the provisions of Chapter 9 of this title, who in good faith gratuitously renders emergency care or services at the scene of an emergency, except in a licensed dental office or public or private hospital, to a person or persons in need thereof, shall be liable for any civil damages as a result of any act or omission by such person in rendering the care or services or as a result or any act or failure to act to provide or arrange for further dental care or treatment or care for the person involved in the emergency.”

EMPLOYEE HIRING
The Immigration Reform and Control Act of 1986 affects all employers, regardless of the number or national origin of persons employed. The IRCA requires all employers to complete an Employment Verification Form I-9 for every new employee hired after November 6, 1986. For these forms, contact the INS at: Immigration and Naturalization Services, 800-870-3676, www.ins.usdoj.gov

Employers must have federal and state tax identification numbers to report employee wages and to remit payroll taxes. For your Federal Employer Identification Number (EIN), call: Internal Revenue Service (IRS) at 800-829-1040 or www.irs.ustreas.gov

Information on a state employer identification number is available at: LA Department of Revenue and Taxation, 225-219-7318, http://www.rev.state.la.us/

EMPLOYER POSTER REQUIREMENTS
State and federal laws require employers to display certain posters. Below is a list of state-required posters distributed by the Louisiana Department of Labor, available at any statewide Job Service Office:
1.   Notice to Workers regarding Unemployment Insurance Benefits (LDET-ES 74)
2.   Louisiana Minor Labor Law Placard (if employing anyone age 17 or younger)
3.   Notice of Compliance to Employees
4.   Sickle Cell Anemia (If employing 15 or more people), Civil Rights Bureau, Department of Social Services, 225-342-2700
5.   Smoking
6.   Out-of-State Motor Vehicles
7.   Fair Employment and Age Discrimination

The federal government requires the following posters:
1.   Minimum Wage, WH Publication 1088 (required for all businesses subject to the Fair Labor Standards Act). Obtain this poster from the U. S. Department of Labor, Wage and Hour Division, by calling 504-589-6171 or visiting http://www.dol.gov/osbp/sbrefa/poster/main.htm
2.   Employee Polygraph Protection Act. Obtain this poster from the U. S. Department of Labor, Wage and Hour Division, by calling 504-589-6171 or visiting http://www.dol.gov/osbp/sbrefa/poster/main.htm
3.   Job Safety and Health Protection, OSHA 2203. Obtain this poster from the Federal OSHA Office by calling 225-389-0474
4.   Family and Medical Leave Act, WH Publication 1420 (for employers with 50 or more employees). Obtain this poster from the U. S. Department of Labor, Wage and Hour Division, by calling 504-589-6171 or visiting http://www.dol.gov/osbp/sbrefa/poster/main.htm
5.   Equal Employment Opportunity (for employers with 20 or more employees). Obtain this poster from the EEOC office by calling 800-669-3362 or visiting http://www.dol.gov/osbp/sbrefa/poster/main.htm
6.   Genetic Information and Privacy. For more information on posters required by state and federal law, visit http://www.laworks.net/Forms/er/EmployerHandbook.pdf

FEE SPLITTING
Louisiana Revised Statute 37:776 prohibits fee splitting, although it does not forbid licensed dentists from practicing in a partnership or professional corporation and sharing professional fees, nor does it forbid a licensed dentist from employing another licensed dentist. Any acceptance, sharing or division of dental fees by a dentist under suspension or revocation shall be sufficient cause for the State Board of Dentistry to withhold the reinstatement of his/ her dental license until the Board determines he/she has been fully rehabilitated. For more information, contact:
Louisiana State Board of Dentistry
One Canal Place, Suite 2680
365 Canal Street
New Orleans, LA 70130
504-568-8574
www.lsbd.org

FREEDOM OF CHOICE
Louisiana Revised Statutes 22:1513 states that “no health insurance policy or employee benefit plan delivered in the State of Louisiana shall prevent any person who is a party to or beneficiary of any such health insurance policy or employee benefit plan from selecting the dentist of his choice to furnish the dental care services offered by the policy or plan, or interfere with such selection.” However, the courts have held that ERISA, the federal statute governing self-insured employee benefit plans, preempts state “any-willing-provider laws.” For more information, download the Freedom of Choice: The Law is on Your Side fact sheet or e-mail the LDA at info@ladental.org.

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GENERAL ANESTHESIA: HEALTH PLAN COVERAGE
Under Louisiana Revised Statute 22:228.7, health care plans issued, delivered or renewed in Louisiana after January 1, 1998, are required to provide benefits for anesthesia rendered in a hospital setting and for associated hospital charges when the mental or physical condition of the insured necessitates that dental treatment be rendered in a hospital setting. In determining whether performing dental procedures under general anesthesia is appropriate for a patient, dentists are required to consider as utilization standards the Indications for General Anesthesia as published in the reference manual of the American Academy of Pediatric Dentistry (AAPD). Coverage will not apply to treatments rendered for TMJ.

Insurers may apply the following restrictions:
· Coverage to include only procedures performed by dentists who have hospital privileges.
· Coverage to include only procedures performed by pediatric dentistry specialists or fully accredited specialists in a recognized dental specialty for which hospital privileges are granted.
· Prior authorization required in the same manner as for other covered medical conditions.

The LDA has prepared a packet of complete information about the law, including form letters that may be sent to insurers who do not appear to be complying fully with the law.  To obtain a packet, contact the LDA at 800-388-6642, 225-926-1986 or e-mail: info@ladental.org

HAZARDOUS WASTE DISPOSAL AND TRANSPORTATION
Medical waste from health care facilities must be treated in a way that destroys its potential for causing disease, prior to disposing it in a landfill. Acceptable treatment methods may include incineration, steam sterilization (or autoclaving), and chemical disinfection. Waste that has been treated but is still recognizable as medical waste (for example, waste that has been autoclaved which is still in a red bag or sharps container) must be labeled with the name of the facility that generated it, the type of treatment method used, and the name or initials of the person in charge of treatment. Disposal of medical waste must be in accordance with all federal, state, and local regulations.

Except for small quantities, potentially infectious medical wastes can be transported off the site where they were generated only by transporters permitted by the State Health Officer. Small quantity generators, including dentists’ offices, may transport small quantities of properly packaged and labeled wastes to approved large quantity generators, permitted storage facilities, or permitted treatment facilities without meeting the requirements for transport and treatment that large quantity generators must meet. Transportation of potentially infectious waste (except by small quantity generators) is governed by Section 27:023 of the regulations.

To avoid violating federal regulations and facing severe penalties, call: Department of Environmental Quality, 225-765-0355, www.deq.state.la.us

HIPAA (Health Insurance Portability and Accountability Act)
This federal law restricts the use of patient information and imposes standards for electronic transmission of health information. Dentists who utilize electronic transactions in their practices must comply with the provisions of HIPAA. Members may purchase a HIPAA Privacy Kit through the ADA by calling (800) 621-8099, and other HIPAA compliance tips can be found at www.ada.org.

HIV/HBV (INFECTIOUS DISEASES)
Under Louisiana Revised Statute 37:1747, each board licensing health care providers must establish administrative rules on practice requirements based on CDC guidelines to protect the public against the transmission of Hepatitis B or the HIV virus.

HIV Informed Consent Form
Upon receipt of written informed consent of patients, health care providers may test them for HIV. For a copy of Test for HIV Infection Written Informed Consent Form, contact:
Louisiana Department of Health and Hospitals
Office of Public Health – HIV/AIDS Program
234 Loyola Avenue, 5th Floor
New Orleans, LA 70112
504-568-7474
E-mail: hivweb@dhh.state.la.us
http://www.oph.dhh.state.la.us/HIVAIDS/index.html

HIV Test Result Disclosure
With few exceptions for special circumstances, a health care provider must have a patient’s written permission to release information on test results. The provider should review the release form with the patient to ensure that the patient understands the form’s content and purpose. If that patient is illiterate or does not read or speak English, an appropriate translator (i.e., interpreter for the deaf, blind, foreign language, etc.) must be furnished. In order to comply with the privacy regulations of HIPAA (the Health Insurance Portability and Accountability Act), it is recommended that a consent form for the release of information should state the following:
· the purpose of the disclosure;
· the patient’s right to review the health care provider’s privacy notice; and
· an explanation of the process by which the patient may revoke or request restrictions on the consent to disclosure.

The signed release form should be dated and kept on file by the health care provider for at least six years. The patient may cancel permission to release results at any time, except when the information has already been released. 

HIV Positive Dentists
Under Chapter 12 of the Rules of the Louisiana State Board of Dentistry (LSBD), any dental health care provider who is seropositive for HBV, HCV or HIV, and who in the course of practice may perform or participate in an exposure-prone procedure, must properly report their status and receive authorization from a board-appointed expert review panel before they may perform any exposure-prone procedures. Such reports are completely confidential, except as may be necessary to investigate or prosecute suspected violations.

Under the American Dental Association’s Principles of Ethics and Code of Professional Conduct, any dentist who becomes impaired in any way is urged to seek medical advice and treatment from a qualified professional and to limit his/her practice activities to areas that will not endanger patients or dental staff. For more information, contact:
Louisiana State Board of Dentistry
One Canal Place, Suite 2680
365 Canal Street
New Orleans, LA 70130
504-568-8574
www.lsbd.org

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Infection Control
The Centers for Disease Control has issued universal precautions advising health care providers to use the same protective measures which would prevent the transmission of the AIDS virus or other infectious disease with all patients.  These precautions include:
·    Wearing gloves, masks and protective eyewear.
·    Washing hands before and after each treatment.
·    Changing gloves after each patient.
·    Disposing of needles and other sharp items in special containers.
·    Properly disposing of waste items and contaminated material.

HIV infection alone does not justify the limiting of professional duties or automatically mandate disclosure, unless the dental health care worker poses a risk of transmitting infection through non-compliance with universal precautions, a lack of infection control competence or shows signs of functional impairment.

The CDC publication Recommended Infection-Control Practices for Dentistry is included in the booklet published by the Louisiana State Board of Dentistry and may be ordered or accessed online through the Centers for Disease Control - Division of Oral Health, 770-488-6054, or 888-CDC-FACT (232-3228) for automated information or http://www.cdc.gov/

INFORMED CONSENT
Under Louisiana Revised Statute 40:1299.131, a dentist must receive consent for any dental treatment after the patient has been informed in general terms of the nature and purpose of the dental treatment and the risks of death, brain damage, quadriplegia, paraplegia, loss or loss of function of an organ or limb, or disfiguring scars associated with specific dental treatment. The patient must be given an opportunity to ask questions about the treatment and have them answered satisfactorily. The dentist has the responsibility of obtaining written informed consent of a patient, but this responsibility may be delegated to a lay or professional employee of a hospital or dental office. For more information, contact your malpractice insurer carrier or the LDA at 800-388-6642, 225-926-1986 or e-mail: info@ladental.org

INSURANCE
The LDA sponsors the following types of insurance coverage through its administrator, Gilsbar, Inc.:
·     Major Medical
·     Business Overhead Expense
·     Personal Accident
·     Term life
·     Disability Income
·     In-Hospital Indemnity
·     Medicare Supplement
·     Long Term Care

For more detailed information call: Gilsbar, Inc. at 800-445-7227

Through its subsidiary, Louisiana Dental Services, Inc. (LDS), the LDA endorses a professional liability insurance program. For more information, call The Medical Protective Insurance Company at 800-344-1899. LDS also endorses Robert Ellis & Associates for Business Office Protection insurance. If you would like new or different quotes on your business property insurance, please contact your LDA Account Manager Stormy Blair, Robert  Ellis  & Associates, 1-888-503-5547 or sblair@ellis4u.com.

For dental insurance, the LDA endorses Crescent Dental Plans®, a group dental benefits program. Call 1-888-503-5547 for more information about Crescent Dental Plans®, offered through the LDA/LDS subsidiary, Professional Dental Plans, Inc.

INSURANCE CLAIMS
Chapter 1 of Title 22 of the Louisiana Revised Statutes §§250.31 through 250.37 provides specific time limits for payment of health insurance claims and provides for monetary penalties against any insurer who fails to pay claims promptly. The law does not apply to the State Employees Group Benefits Program, however.

When a health care provider submits an electronic claim, the insurer must pay the claim within 25 days from the date of transmittal.

When a provider submits a non-electronic claim, under a contract, the insurer must pay the claim within 45 days from the date of transmittal. If the claim is submitted more than 45 days after the date of service, or if the provider has had to resubmit a claim that was incomplete, the insurer must pay the claim within 60 days from the date of transmittal of a correct claim form.

When a provider submits a non-electronic claim without a contract, the insurer must pay the claim within 30 days.

An insurer who fails to pay a claim within these specified time periods is liable for “a late payment adjustment equal to one percent of the amount due.” If more than 25 days pass from the date payment was due, the insurer must pay “an additional late payment adjustment equal to one percent of the unpaid balance due for each month or partial month that such claim remains unpaid.”

Click here to obtain a copy of the LDA information sheet, Prompt Payment of Insurance Claims, or e-mail the LDA at info@ladental.org.

JURY DUTY
Louisiana Revised Statute 23:965 requires employers to provide to employees a paid leave of absence from work (up to one day) for jury duty, without loss of sick or vacation leave or any other benefits. It prohibits an employer from discharging an employee, without cause, who has been called to serve on jury duty. 

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LIMITED LIABILITY FOR PROVIDERS OF FREE CARE
Louisiana Revised Statutes 9:2799.5 limits the civil liability of health care providers for gratuitously rendered care to instances of gross negligence or willful or wanton misconduct. For providers to enjoy this limited liability, the treatment must be rendered: (1) in a community health care clinic, or (2) in the provider’s office pursuant to an arrangement with a community health care clinic and for a patient who has been screened by the community health care clinic and found to be financially eligible to receive gratuitous services. Under this statute, a patient’s financial eligibility is defined generally as having no access to health care benefits through a public entitlement program for the treatment rendered. In other words, the patient must not be eligible for Medicaid, Medicare, LaCHIP, etc. Most community health care clinics also require that the patient may not have private insurance coverage.

In addition, either at the time of the initial screening or at the time health care services are provided, the clinic or provider must give the patient written notice of the limitation of liability and conspicuously post a similar notice of the limitation of liability for patients to see.

More detailed information is available in the LDA information sheet, Limited Liability for Gratuitous Provision of Health Care Services. To obtain a copy, contact the LDA at 800-388-6642, 225-926-1986 or e-mail: info@ladental.org

MEDICAL MALPRACTICE
Louisiana Revised Statutes 40:1299.41, the Louisiana Medical Malpractice Act, defines malpractice as “any unintentional tort or any breach of contract based on health care or professional services rendered, or which should have been rendered, by a health care provider, to a patient, including failure to render services timely and the handling of a patient, including loading and unloading of a patient, and also includes all legal responsibility of a health care provider arising from acts or omissions in the training or supervision of health care providers, or from defects in blood, tissue, transplants, drugs and medicines, or from defects in or failures of prosthetic devices, implanted in or used on or in the person of a patient.”

According to Louisiana Revised Statues 9:5628, “no action for damages for injury of death against any physician, ... dentist, ... hospital duly licensed under the laws of this state, or community blood center or tissue bank as defined in R.S. 40:1299.41(A), whether based upon tort, or breach of contract, or otherwise, arising out of patient care shall be brought unless filed within one year from the date of the alleged act, omission or neglect, or within one year from the date of discovery of the alleged act, omission or neglect; however, even as to claims filed within one year from the date of such discovery, in all events such claims shall be filed at the latest within a period of three years from the date of the alleged act, omission or neglect.”

MEDICAL RECORDS
Louisiana Revised Statute 40:1299.96 requires health care providers to furnish to a patient or his legal representative, upon request, copies of any information related to the patient, which the health care provider has transmitted to any company, agency or person. The law states that the patient’s medical records are the property and business records of the health care provider. The law authorizes the following schedule of charges for copies requested:  1 - 25 pages:  not to exceed $1 per page; 26 - 500 pages:  not to exceed $.50 per page; over 500 pages:  not to exceed $.25 per page; handling charge: not to exceed $15 for hospitals, nursing homes and other health care providers and actual costs incurred for postage. Also: x-rays, microfilm and electronic and imagin media, upon payment of reasonable reproduction costs and a handling charge of $20 for hospitals; $10 for other health care providers. The health care provider must comply with requests in at least 15 days. Any court-ordered records will require the health care provider to pay reasonable expenses and attorneys fees. Access to records may be denied only if the knowledge of the information would be harmful to the health or welfare of the patient or any other person.

Medical records should be retained for a minimum of six years from the date of last treatment. Graphic matter, images, x-ray films, and such data should be retained for three years, unless the patient requests a longer period in writing.

MEDICAL WASTE DISPOSAL
The Office of Public Health regulates the management and disposal of medical waste, infectious waste and potentially infectious biomedical waste. Among the requirements of the Sanitary Code (Title 40 of the Louisiana Revised Statues), is the requirement that used sharps be encased so as not to produce injury. A copy of the Sanitary Code on Management of Refuse, Infectious Waste, Medical Waste, and Potentially Infectious Biomedical Waste, Chapter XXVII, may be ordered or viewed online via:
DHH Office of Public Health
Infectious Waste Program
6867 Bluebonnet Blvd.
Baton Rouge, LA 70810
225-763-5553
http://www.oph.dhh.state.la.us/sanitarianservices/infectiouswaste/index.html

NATIONAL PRACTITIONER DATA BANK
The National Practitioner Data Bank (NPDB) contains information about dentists and other licensed health care practitioners who have had adverse actions taken against them with respect to their professional competence or conduct, or who have had payments made on their behalf in response to written claims of malpractice. The U.S. Department of Health & Human Services operates the NPDB. Its purpose is to improve the quality of health care by encouraging hospitals, state licensing boards and other health care entities, including professional societies, to identify and discipline those who engage in unprofessional behavior, and to restrict the ability of incompetent health care practitioners to move from state to state without disclosure or discovery of previous damaging or incompetent performance. Health care providers also have access to the files. For more information, contact the American Dental Association at 800-621-8099 or http://www.ada.org/ or the National Practitioner Data Bank at 800-767-6732 or http://www.npdb-hipdb.com/

NATIONAL PROVIDER IDENTIFIER FOR HEALTH CARE PROVIDERS
The National Provider Identifier (NPI) is a unique, government-issued, standard identification number for individual health care providers and provider organizations like clinics, hospitals, schools and group practices. The government has contracted with an external company for processing applications and developing these random 10-digit numbers for applicants. Applications to obtain an NPI began on May 23, 2005.

Anyone who uses standard electronic transactions, like electronic claims, eligibility verifications, claims status inquiries and claim attachments, will be required by federal law to start including NPIs on electronic transactions not later than May 23, 2007. In addition, those dentists who use only paper, voice and fax to transmit these communications may find NPIs useful or necessary for other reasons. The ADA encourages all dentists to apply for NPIs, particularly those using (or planning to use) electronic transactions. The NPI has some advantages over identifiers now in use:

• Once implemented across the health care industry, the NPI will be accepted by all dental plans as a valid provider identifier on electronic dental claims and other standard electronic transactions.
• Dentists will not have to maintain multiple, arbitrary identifiers required by dental plans, nor will they have to remember which number to use with which dental plan.
• Introduces an important element of standardization to electronic transactions that should improve transaction acceptance rates.

However, the NPI does not do any of the following:

• Replace the DEA number when required for prescribing controlled substances or other DEA-regulated activities.
• Replace state-issued licenses and certifications verifying a provider's licensing or qualifications.
• Replace Social Security Number, Individual Tax ID, or Employer ID for tax purposes.

Early application for and receipt of an NPI mean your practice will be ready to submit NPI data when requested by a patient’s health plan, a clearinghouse, your system vendor, or a fellow health care provider who needs it for billing purposes. It is very likely that plans will begin requesting NPIs prior to May 23, 2007, for electronic transactions. Even if a dentist does not use electronic transactions, it is quite likely that a health plan might require the dentist to use an NPI on paper claims.

Applying for an NPI is free and relatively easy: Visit http://nppes.cms.hhs.gov, read the instructions carefully, complete the questionnaire and submit your application. This takes about 20–30 minutes. After confirmation of your data’s receipt, you should receive your NPI via e-mail in one to five business days. A downloadable application form is also available. Download the application form, print, complete and mail per the instructions. The NPPES does not accept faxed applications. Processing of paper applications takes about 20 business days.